When Should Dermatologists Refer Delusions of Parasitosis Patients to Psychiatry: An Expert Recommendation

Main Article Content

Michael Nemeh
John Koo
Mio Nakamura


psychodermatology, psychocutaneous disease, delusions of parasitosis, delusional infestation


Many patients with delusions of parasitosis (DoP) prefer to be managed by dermatologists rather than mental health professionals (MHPs). While some patients with DoP can be managed by dermatologists, others must be referred to MHPs. The purpose of this article is to assist dermatologists in determining when to refer their DoP patients to a MHP. We propose 3 criteria for making this determination: whether the delusion is primary or secondary, whether the delusion is encapsulated and realistic or global and bizarre, and the patient’s degree of delusional intensity. Patients with secondary DoP, delusion that is global and bizarre, and DoP with a high degree of delusional intensity should be referred to a MHP.


1. Association AP. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.

2. Brownstone N, Koo J. The Koo-Brownstone staging system as a tool to assist in the management of patients with a possible diagnosis of dermatological delusions: an experts suggestion. J Dermatolog Treat. Dec 2022;33(8):3199-3201. doi:10.1080/09546634.2022.2112548

Most read articles by the same author(s)